Linear endobronchial guided sampling of accessible mediastinal lesions is well established as a first-choice modality for lung cancer mediastinal staging. Parenchymal lung lesions, however, are routinely accessed by either a percutaneous (CT-guided) or a bronchoscopic approach. There have been few direct comparisons between the percutaneous approach and bronchoscopy, endobronchial ultrasound (EBUS), or mediastinoscopy regarding diagnostic accuracy, and it remains unknown which sampling technique is the safest and offers the most adequate material for comprehensive biomarker testing.
Newly released guidelines published in the Journal of Thoracic Oncology provide evidence regarding the safety and sampling adequacy for comprehensive biomarker testing of bronchoscopy-guided lung parenchymal biopsies as compared to percutaneous biopsies, and EBUS-guided lymph node sampling as compared to mediastinoscopy. According to the guidelines, which are the result of a multidisciplinary panel convened by the American Association of Bronchology and Interventional Pulmonology (AABIP) and the Early Detection & Screening Committee of the International Association for the Study of Lung Cancer (IASLC), the tissue provided by guided bronchoscopy sampling is comparable to that provided by percutaneous (CT-guided) biopsy and delivers a superior safety profile, particularly when contemporary navigational technologies are used.
Key Findings
Across the analyzed studies, the panel found that bronchoscopy-guided parenchymal biopsies yielded molecular-testing specimens equivalent in quality and quantity to those obtained via percutaneous biopsy, and guided bronchoscopy consistently produced fewer serious complications—such as pneumothorax and significant bleeding—than percutaneous approaches. For lymph-node staging, EBUS continues to rival mediastinoscopy in diagnostic accuracy while offering lower morbidity for mediastinal assessment.
“These recommendations are immediately actionable for clinicians deciding how best to obtain tissue for biomarker analysis in suspected or confirmed lung cancer,” said Abhinav Agrawal, MD, Director of Interventional Pulmonology and Associate Professor of Medicine & Cardiovascular/Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “They should also inform the design of future clinical trials by highlighting both sample adequacy and the safety advantages of minimally invasive bronchoscopic techniques.”
Disclosure: For full disclosures of the study authors, visit jto.org.
